Epidural Steroid Injection

An Epidural steroid injection can be defined as a minimally-invasive procedure, with steroids being injected into the epidural space. The pain relieving effect of the procedure is temporary but, nevertheless, it serves as a good treatment for a wide range of medical conditions. Epidural steroid injections were used for the first time around the 1950s, being part of the conservative or non-surgical approach for different types of painful syndromes.

The epidural steroid injection contains the active medication or corticosteroid, such as triamcinolone or betamethasone, and the anesthetic agent (such as lidocaine or bupivacaine). As it was already mentioned, the medication is going to be injected into the epidural space, which is the area between the vertebrae and the protective lining of the spinal cord (dura). These injections require a maximum amount of attention and precision, as there are a lot of blood vessels and nerves in the area that can be damaged in the process.

Why are Epidural Steroid Injections given?

These are the main reasons (or afflictions) that should make you consider the epidural steroid injections:

• Low back pain
• Pain in the leg (caused by the compression of a nerve root in the spinal cord)
• Temporary pain relief from other medical problems
• Continuance of physical therapy program after some or all of the pain has been relieved
• Cervical or thoracic radiculopathy
• Narrowing of the intervertebral spinal canal (spinal stenosis)
• Disc herniation
• Degenerative disc disease (arthritis)
• Bone spurs
• Thickening of the spinal ligaments
• Cysts formed around the spinal joints
• Abnormal alignment of the spine (caused by slipped vertebral discs, spondylolisthesis)
• Sciatica

What does an Epidural steroid injection do?

These are the beneficial effects you will obtain from being treated with epidural steroid injections:

• Pain relief – this effect is temporary, ranging from a couple of weeks to several months (especially recommended in acute episodes of pain); most commonly treated – severe low back pain, leg pain (sciatica – radicular pain), pain caused by cervical or thoracic radiculopathy
• Reduction of inflammation in patients who suffer from medical conditions such as spinal stenosis, disc herniation or other degenerative disc disease, such as arthritis
• Flushing effect – the corticosteroid injections allow for the elimination of inflammatory proteins, which are responsible for both the inflammation and the pain
• Improved overall functioning due to the pain relief and anti-inflammatory properties (patients can resume daily living activities and continue their physical therapy sessions)
• Break the cycle of pain and inflammation (however, it is important that they do not cure the painful condition one is suffering from; they merely represent a symptomatic treatment, with temporary effects)
• Elimination of other symptoms experienced by the patient, such as numbness, tingling sensation or paresthesia (as the inflammation around the nerve roots is reduced)

Cost

In calculating the cost of the epidural steroid injections, there are several factors that you need to take into consideration, such as: the clinic in which the procedure is performed, the fees for the doctor and how many (and how frequent) you will need to have the injections performed. In general, these are recommended to be made at several months apart and used only for really intense or acute episodes of pain. On average, a single epidural steroid injection can cost around several hundreds of dollars. You can also check your insurance policy and see if you are covered (partially or totally) for such kind of procedures. This might help you reduce the overall costs for the epidural steroid injections.

Risks

These are the risks that come with epidural steroid injections:

• Temporary numbness at the site of the injection
• Infection – this may be caused by the usage of medical equipment that is not sterile or by an infectious microorganism found in the clinic
• Impaired functioning of the bowels or bladder (temporary)
• Dural puncture – this occurs when the protective membrane of the spinal cord (dura) has been punctured by the needle; if this happens, the doctor will take a small amount of blood from a vein in the arm and insert in the respective place. The blood will form a clot, covering the small puncture in the dura and preventing the spinal fluid from leaking out.
• Hemorrhage – rare complication, occurs more commonly in those who also suffer from bleeding disorders, such as hemophilia
• Nerve injury – the damage to the nerve can be caused in a direct manner (inexperienced doctor – nerve damage with the needle) or appear after other complications of the procedure (hemorrhage or infection).
• Allergic reaction to the injected substances (emergency treatment might be required)
• Paralysis – rare complication, occurs due to severe damage done to the spinal nerves with the needle.

Side effects

These are the side-effects that can appear after receiving epidural steroid injections:

• Intense pain at the site of the injection
• Headaches (more frequent in case of dural puncturing; go away on their own in approximately one day)
• Flushing in the face and chest
  • Can last for several days
  • Warm feeling or increase in body temperature (low-running fever)
• Anxiety
• Lack of sleep (insomnia)
• High-running fever (may be suggestive of an infection)
• Reduced immunity (temporary – effect of the corticosteroid medication)
• Changes in the menstrual cycle
• Temporary water retention (perceived as weight gain)
• Increased blood sugar levels (these injections should be made with caution in diabetic patients)
• Mood swings
• Numbness or mild muscular weakness (temporary effect).

Recovery time

The steroid treatment is going to start working in approximately one to three days but, on average, it takes one week for its effect to be felt. During the first days after the procedure, the majority of the patients experience an intensification of the pain. The recovery time is reduced, with the exception of the patients who have suffered from complications (bleeding, infection or nerve damage). The recovery time is shortened if the patient starts the physical therapy program immediately after the pain relief was obtained.

After care

Immediately after the procedure, you might have to take anti-inflammatory medication and apply ice to the site of the injection, in order to reduce the pain and discomfort generated. In general, it is recommended to avoid intense physical effort for the first days after the procedure. It is for the best that you limit the activities that require strenuous effort and take the pain medication exactly as instructed. If you are experiencing symptoms such as facial flushing, anxiety or lack of sleep, do not sleep. Remember that these are only the side-effects of the medication and they will go away on their own, without requiring any specific treatment or intervention. Avoid soaking the area of the injection for the next two days after the procedure; however, you are allowed to shower.

Video

Watch how the Epidural steroid injection is given in the below video.